Healthcare Provider Details

I. General information

NPI: 1366373755
Provider Name (Legal Business Name): LIZ WILNETTE TORRES- NEVAREZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/26/2026
Last Update Date: 05/26/2026
Certification Date: 05/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1974 HICKORY RUN W
ORANGE PARK FL
32073-8830
US

IV. Provider business mailing address

1974 HICKORY RUN W
ORANGE PARK FL
32073-8830
US

V. Phone/Fax

Practice location:
  • Phone: 904-418-3155
  • Fax:
Mailing address:
  • Phone: 904-418-3155
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMA61488
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: